Research has found nine percent of the U.S. population will be affected by an eating disorder in their lifetime. Many states are considering legislation to address this, with some focusing on regulation of social media.
In January of 2021, Emma Warford was diagnosed with anorexia.
"My eating disorder started in March 2020," Warford said. "Amidst the pandemic, all the chaos of the world, I just started counting calories. You know, being on social media ... you see diet culture posts promoting weight loss. So, I went along with what everyone else was doing and just started off slowly, like increasing my exercise, decreasing what I was eating."
She considers herself a successful student, on track to go to UCLA in the fall for political science and pre-law. However, she says isolation and stress during the pandemic was too hard to handle.
"I started using calories as a way of dealing with all the stress," Warford said. "It was my main coping mechanism because I really didn't have any coping mechanisms."
Eventually, Warford was admitted to the hospital, but she wasn't alone in her experience. The National Eating Disorders Association says when the pandemic started, emergency room admissions among adolescent girls doubled.
Elizabet Altunkara is the director of education at the National Eating Disorders Association.
"We've seen people who were previously engaging in disordered eating, really start struggling with a full-blown eating disorder, or we started hearing from people who were in recovery to relapse during the pandemic," Altunkara said.
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Now, legislators across the country are taking action. Amanda Raffoul has been pushing to ban the sale of weight loss pills to minors. She is part of an advocacy partnership between Harvard University and Boston Children's Hospital called the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED.
"Some states are working more on the spectrum of improving access to care around eating disorders," Raffoul said. "Other states are working on improving medical standards. So, for example, training of physicians, educators for screening of eating disorders."
Raffoul says there's been legislative movement related to eating disorders in states like California, Colorado, Texas, Kentucky, New York, Massachusetts and Maryland.
"There was also a pretty big push last year, federally, to try and pass a bill through Congress that would, similarly, put in protections for youth and online spaces as it relates to eating disorders," Raffoul said. "There's a growing body of evidence that shows that certain types of social media use can increase the risk of developing disordered eating behaviors, especially for young people."
Warford says social media influenced her battle with anorexia in both good and bad ways.
"I've been able to find a good recovery community to support me throughout my journey," Warford said. "But at the same time, I've also seen the parts that are degrading and contribute to mental illness. You know, parts that are encouraging diet culture and, even, parts that encourage eating disorders. There's Twitter accounts that glamorize anorexia, and that was definitely really hard to see. And it was hard enough on my own to choose recovery, but parts like that made it even harder."
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Emily Hemendinger at the University of Colorado Anschutz Medical Campus has studied how social media can impact eating disorders.
"With eating disorders, genetics and temperament and family life kind of load that gun, and things like social media and society pull the trigger," Hemendinger said.
Hemendinger says algorithms are particularly concerning because if somebody watches one video related to an eating disorder, platform algorithms will feed you more and more of those videos.
Raffoul says it's those algorithms that legislators are hoping to change.
"Social media platforms don't have any sort of legal obligation to release data or details for researchers like myself, or for public health advocates and policymakers," Raffoul said. "One of the things that our legal team has highlighted as a potential avenue is conducting assessments or audits of what algorithms end up showing to vulnerable youth."
In the meantime, medical professionals, social workers and people like Emma Warford want other teens to know that recovery from an eating disorder is possible. Awareness, education, support groups and access to care is what Warford says led her to where she is today. She says she was officially discharged from all treatment in November of 2021.
"Physically, I feel, obviously, energized," Warford said. "My grades have improved a ton through my recovery, just because I actually have better cognition, and my brain has more energy to work. In general, I didn't think I'd be as happy as I am in recovery. But in reality, I'm so much better than my life was before."
